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Dementia Horizons | Workshop 11 | Home Safety Video Module 11 Transcript Home. What does that mean to you? Are you surrounded by pictures and mementos that have a story or bring you joy? Does home mean safety, peace, and familiarity? When you come home, do you love a particular scent or smell? Our job today is to learn how to adapt a home for someone whose brain and senses are changing over time, due to progressive cognitive impairments that we call Dementia. That way, you can better understand why modifications to create a safer home environment are necessary in the first place. It is also essential to know how the underlying diseases or disorders that can cause Dementia may impact the senses. Let's start with vision or eyesight. Peripheral vision narrows, meaning that the person sees primarily what is directly in front of them, like looking through a tunnel, with less ability to see what is happening on the sides. Because of this, people living with Dementia may then bump into objects if pathways are narrow or cluttered. Also, identifying shapes and objects can be difficult if the lighting is dim. For example, the vacuum can look like a small child in the distance. Shadows can be misinterpreted, especially at night, looking like strangers entering the room. The shape, purpose, or function of an object can be misconstrued, so a TV remote control and a cell phone can look the same. Because of changes in the brain, which keeps track of what does what and how, managing devices can become overwhelming. Depth perception changes over time. It may be more difficult to safely walk up or down stairs, or know how to step into or out of a bathtub. As you can anticipate, there is a higher risk of slips, falls, and injuries. The brain also controls our ability to move our legs and maintain balance while walking. As Dementia progresses, steps shorten, people may shuffle their feet; and reflexes slow, creating another reason why the risk of trips and falls is a common concern. The sense of smell may diminish, making it problematic to identify smoke, foul odors, or spoiled food. It is also common for hearing to become impaired with age. Therefore, older people living with Dementia can have more difficulty deciphering sounds and voices. This is especially true when there is too much background noise or people are talking simultaneously. Although this may not happen to everyone with Dementia, hallucinations can occur. Hallucinations are perceptions of having touched, heard, seen, tasted, or smelled something that does not exist. Given this wide range of potential changes, I hope you can see why creating a home environment that supports safety and thriving is wise and loving. Hearing all of this may be overwhelming to absorb. Take four deep breaths. By anticipating challenges and making proactive adjustments inside and outside the home, care partners and caregivers can significantly enhance the quality of life for those living with Dementia and provide reassurance for themselves. You can do hard things, and I am here to help you get started. Let's start by imagining yourself walking into the kitchen. Objects might look different to a person living with Dementia. Now, scan the room. Take inventory of what is inside the cabinets and drawers, and consider the following recommendations. Remove knives and other sharp utensils. Purchase kitchen appliances, such as coffee makers, with automatic shut-off. Disconnect the garbage disposal, or make it very difficult to turn on. If possible, remove the knobs from the stove. Lock up cleaning supplies. People may misinterpret cleaning solutions for juice. Be especially sure to secure dishwasher soap pods. They are poisonous and commonly mistaken for candy. Remove anything mistaken for food, such as fake fruit in a bowl. Clear the refrigerator of expired food regularly. Some cabinets may require safety locks to keep items hidden and secure. Keep the fire extinguisher or fire blanket within easy reach. Label cabinets so that things are easier to find. This will also help support a sense of independence. Use chairs that are sturdy, with armrests that make it easier to get in and out of. As you walk through the hallways, clear the pathways. Remove throw rugs that can be tripping hazards, and add additional lighting where necessary. Consider using non-skid wax on floors. If not, be sure the person wears non-skid shoes or slippers when walking on wooden or tile surfaces. Some people with Dementia find it easier to locate rooms in the house if way-finding signs are in place. These signs usually have the room's name in large print and a picture. Use brightly colored tape or paint to mark the edges of steps, or changes in the flooring. Install or secure handrails on stairs. If steps become too challenging, the person may need to remain on one main floor. If clear glass doors or partitions are present in your home, use decals to prevent people from bumping into them. Now, let's imagine going into the bedroom or bedrooms. I would encourage you to decorate the bed with a color that contrasts with the rug or floor so that it can be easily identified. For example, a blue bedspread and a cream colored carpet. Install motion detector nightlights for times when someone wakes up and needs to find the restroom. Again, be sure to remove throw rugs. Listen for low battery chirps from smoke alarms, and don't wait to change them. Supervise the use of heating pads or electric blankets. Remove clutter, and label drawers and cabinets. Moving into the bathroom. This is an area that requires particular attention: Remove or secure prescription or over-the-counter medications from cabinets, and place mouthwash and colognes where they can be supervised during use. Replace door locks with non-locking levers. Install grab bars in shower and bathtubs. Use a non-slip bath mat. Install non-slip toilet seats that contrast with the color of the floor, making them easier to see. Set water temperature to avoid scalding. Use overflow valves or flood sensors to avoid or detect flooding. Find yourself now in the living room: Remove throw rugs, and use non-slip surfaces if possible. Do your best to declutter. It's easier to pay attention when there is less overstimulation. Remove long cords to avoid tripping. Perhaps in the living room or somewhere else, create a calm and inviting space for the person living with Dementia to relax and have access to meaningful activities such as books, magazines, simple puzzles, paper and pencils for drawing, and music for listening. If guns or a knife collection exists, secure and disable them. Safety, autonomy, and comfort also apply to the backyard and garage: Secure the keys to the snowblower or lawnmower and car. Place power tools out of reach. Disconnect the gas or electric source for the grill. Adjust uneven pathways. Create a space for gardening, walking, sitting and spending time in the fresh air and sunshine. Consider adding a bird feeder or gentle wind chime. Now, you may be wondering, how do I make these changes when the person with Dementia may resist? Start gradually, one slight modification at a time. Have a friend or family member take the person out for a meal or for the day, while the remodeling happens. Do not say anything in advance. Wait to see if the person recognizes the changes. Be matter of fact. Avoid saying you needed this "because...". Instead, say "We needed to make a slight improvement." Creating a safe home environment for individuals living with Dementia requires a combination of understanding, empathy, creativity, and practical adjustments. It's a journey, but ultimately, it can significantly improve the quality of life for both the individuals living with Dementia and their loved ones. Consider these adaptations as a way of loving your spouse, parent, or sibling differently. There we have it: home sweet home. Thank you for joining me today. There was a lot to take in, but use our support material to review and help you implement changes over time. Thank you again. Be well.

Dementia Horizons | Workshop 13 | Driving Concerns Video Module 13 Transcript Welcome. For many of us, driving means a sense of independence, freedom, self-reliance, autonomy, and adventure. Being told that you can no longer drive after 50-60 years of doing so, can be very hard on a person's sense of ego and independence. This video will focus on how to address safety concerns for people who are beginning to show signs of minor cognitive impairment, or possibly are in the very early stages of a diagnosed or undiagnosed disease, that is manifesting as the syndrome of Dementia. Let's start by pointing out that driving is a complex task requiring life and death decision-making, and all sorts of other important cognitive and physical capabilities. As a refresher, Dementia is not a disease. Instead, it is a cluster of progressive symptoms that result from one or more underlying brain diseases or disorders. Medically, it's a syndrome if the symptoms progress to the point of requiring help to complete one or more activities of daily living. That alone, coupled with other cognitive deficits that a doctor can assess, is usually enough to be diagnosed as Dementia. To be clear, if someone has been diagnosed with cognitive impairments advanced enough to be called Dementia, they should not drive, period. Full stop. In fact, most state motor vehicle laws prohibit a person from maintaining a driver's license in such cases. We agree. As our bodies age, it is common for changes to impact our ability to drive safely, and those changes can be downright dangerous for those whose brains are declining a bit faster than what we consider normal for one's age. Moreover, when it comes to driving, there are other people's lives to consider in addition to our own. These changes in ability include problems with depth perception, estimating distance and spacing, narrowing of peripheral vision, difficulty discerning shapes, staying in a lane and understanding road signs, remembering directions and rules of the road, knowing when to stop or speed up, having the motor reflexes to stop suddenly or change direction, keeping impulses in check under stressful conditions or situations. If someone is in the very early stages of cognitive impairment, it does not mean that the person must automatically stop driving. However, when there are noticeable declines in ability, discussing any concerns about driving is essential. Some individuals with minor cognitive impairment continue to maintain insight and self-awareness, and can recognize the need to limit their driving. It may mean that they stick to driving on very familiar roads, avoid days and times that usually have heavy traffic, avoid driving in the rain, sleet, or snow, or driving at dusk or at night. Recognize Any Driving Concerns When Being a Passenger Are they becoming lost in familiar places? Have they successfully used GPS directions on their phone, but now they're getting confused using the apps? As a passenger, observe if they mix up the brake and gas pedals, or have a hard time dealing with four-way stops. Do they drive too slowly and impede traffic, fluctuate in levels of alertness and drowsiness, see things or people that do not exist, become nervous and aggravated while driving, have difficulty changing lanes as well as entering or exiting the highway, have unexplained dents or scrapes, experience frequent fender benders, or damage the wheels or tires by bumping into curbs? What can you do? You may be able to obtain a formal driving evaluation by contacting your State Department of Motor Vehicles. Follow the guidelines for your state, but this type of evaluation should be repeated at regular intervals. Also, it's not uncommon for doctors and hospitals to refer individuals to occupational therapists. They should be able to help with various functional assessments, including driving skills. Make a list of transportation alternatives. Ask friends and family to offer car rides, and find out if there are any community volunteer groups that offer transportation help. Use on-call smartphone apps that summon a driver to the person, along with taxis. Eliminate the need to drive by using online shopping for home delivery of groceries and more. Some individuals and families even find ways for a barber or hairstylist to make home visits. Consider having a transportation buddy for socialization and support. You can also contact your Area Agency on Aging to determine what transportation services may be available in your area. It can become problematic if the person living with minor cognitive impairments progresses to Dementia and starts to lose the insight or knowledge that they are no longer safe to drive. They can resist. They can refuse to stop driving. Or maybe they agree to stop, but forget what they decided days later. Sometimes the only thing that makes them stop is having their doctor or medical professional take the blame, and write on the prescription pad a note that clearly states in large capital letters: DO NOT DRIVE. Alternatively, a private conversation with a non-medical authority figure, such as their faith leader, attorney, accountant, or financial advisor can make a difference. Getting them to come to grips with the change may take more than one approach. However, there are times when the spouse, adult child, or advocate must step in, to maintain the safety of the driver, passengers, other drivers, bicyclists, or pedestrians. Before it's too late, consider hiding the keys, disabling the car, or taking it to the repair shop for work to be done, work that never seems to end. It may become necessary to find secure storage, or sell the vehicle. Selling the car to a family member at a good price benefits both the seller and the buyer. Donating it to a nonprofit, or giving it to a friend in need, may ease the pain of getting rid of it. This is often a tough time: parenting a parent, a reversal of roles. It is also a good opportunity to seek support to address your conflicted feelings, which can often include guilt, anger, and resentment. This is the time to remember that the overall goal is safety for the person with Dementia and other drivers or pedestrians on the road. This safety supersedes the person's anger and desire to drive. Addressing driving safety now is much easier than having to possibly address all that would be involved if someone is seriously injured or even killed on the road. When you are the one who takes away the keys or car, know that you are caring for that person in a way that fills in for the insight that is now lacking. By approaching driving concerns thoughtfully and proactively, you can help ensure the safety and well-being of individuals with Dementia while maintaining their dignity and independence and allowing them to live a more worry-free life. The subject of driving is stressful for all involved. Thank you for listening and watching. You are taking positive steps to help keep your loved one and others safe. Thank you again. I wish you peace on your journey.

Dementia Horizons | Workshop 16 | Meaningful Activities Video Module 16 Transcript Welcome. Thank you for joining me today. Dementia is a progressive condition that affects memory, thinking, behavior, and the ability to perform everyday activities. It is divided into three stages, early, middle, and late. Each stage presents unique challenges and requires different approaches to care and engagement. Meaningful activities can enhance the quality of life for individuals living with Dementia, providing a sense of purpose, reducing distress, and improving overall well-being. This video offers practical tips and ideas for creating meaningful activities tailored to each stage of Dementia. In the early stage of Dementia, individuals may experience mild memory loss and changes in cognitive function, but can still participate in many activities with minimal assistance. This stage focuses on maintaining independence, stimulating the mind, and encouraging social interaction. This can include puzzles and games, word searches, crosswords, Sudoku, and jigsaw puzzles. Encourage reading books, newspapers, or magazines, and writing letters or journaling. Introduce new hobbies such as painting, playing a musical instrument, or learning a new language. The key is to work on learning something new and different to challenge the brain. Physical exercise is crucial for overall health, improving mood and reducing anxiety. Consider regular walks in the park or around the neighborhood, or exercise classes, yoga, tai chi, or dance classes and gardening. Planting flowers or vegetables provides a sense of accomplishment. Maintaining social connections can be described as a meaningful activity, and can help prevent feelings of isolation and depression. This can be accomplished by joining a book club, participating in senior center activities, attending faith-based services or joining hobby groups. Consider volunteering, participating in community service, or helping at local organizations. Regular visits and outings with family and friends are wonderful ways to sustain relationships. Encourage regular, shorter visits to prevent fatigue. Be sure to share how best to communicate or engage differently, as language skills and the ability to initiate conversation or activities can be altered. Include creative and therapeutic modes of expression. Many people with Dementia enjoy arts and crafts, such as drawing, painting, knitting, or scrapbooking. Music is another important way to spend time. You can play an instrument, sing or listen to your favorite songs, take photos or create albums or scrapbooks. As Dementia progresses to the middle stage, individuals may require more assistance with daily activities, and experience increased confusion and memory loss. Activities should be simplified, and focus on familiar tasks that provide comfort and enjoyment. It is important to adapt activities to match the person's abilities. This means simpler puzzles and games, such as larger pieces of jigsaw puzzles, matching games and picture-based activities, short stories, audio books, and magazines with lots of pictures. Consider looking at old photos, discussing past experiences, and creating a memory box with cherished items. Also, physical activities such as chair exercises, stretching, seated yoga, or gentle movements should be modified to ensure they are safe and enjoyable. Enjoy playing balloon volleyball: a fun, low impact way to stay active. Try nature walks: short walks in familiar, safe environments. It may be appropriate to investigate adult day programs designed for individuals with Dementia. Continue to support creative activities focusing on enjoyment, rather than the end result or the finished product. Simple projects like coloring, collage-making, or decorating items. Listen to music, sing along to familiar songs, or play simple instruments like maracas, or encourage the person to tell stories from their past. In the late stage of Dementia, individuals often have severe cognitive and physical impairments and need full-time care. Activities should focus on sensory stimulation, and maintaining comfort and dignity. Focus on engaging the senses to evoke positive emotions and memories. Use soft fabrics, textured objects and hand massages. Engage familiar scents like lavender, baking cookies or flowers. Offer favorite foods and drinks that evoke pleasant memories. Listen to calming music and nature sounds, or read aloud. Watch videos of nature, family photo slideshows, or light displays. Even during the later stages of Dementia, gentle movement can be beneficial: guided movements to maintain flexibility and circulation, to promote relaxation and reduce discomfort. Assist with short walks in safe, familiar environments. Don't forget to provide comfort and emotional support at this stage. Engage in gentle conversation, holding hands and providing reassurance. Play recordings of family members or friends. Minimize noise to maintain a peaceful setting. A sense of security can be created by caring for a soft doll or stuffed animal. Caregivers can also offer quilts with various textures and attachments to keep hands busy. Caregivers, be patient and flexible. Understand that abilities and preferences may change from day to day. Be willing to adapt activities accordingly. Allow the person to do as much as possible independently, offering support only when necessary. Offer praise and encouragement to boost confidence and motivation. Focus on the process, not the outcome. The enjoyment and engagement in the activity are more important than completing it perfectly. Enjoy the moments together. It is an invaluable life skill to learn. Creating meaningful activities for individuals with Dementia requires understanding their abilities, preferences, and the stage of their condition. By focusing on activities that promote cognitive stimulation, physical movement, social interaction, and creative expression, a caregiver can significantly enhance the quality of their loved one's remaining life. Remember, the goal is to provide joy, comfort, and a sense of purpose, helping individuals living with Dementia to live their lives to the fullest. Once again, you've taken the time to consider all the wonderful ways you can help your loved one. As discussed today, non-medical therapies can have the greatest impact on both you and the one you care for. You are the light and sunshine that make all things possible. Thank you for joining me today to learn more about how to create meaningful activities.

Dementia Horizons | Workshop 6 | Ambiguous Loss Video Module 6 Transcript I want to welcome you today. Thank you for being here. Caring for a loved one with Dementia can be a challenging and emotional journey. Dementia is a progressive condition that not only affects the individual but also their family members and caregivers. One of the unique challenges of Dementia is dealing with ambiguous loss, which is the feeling of grief and loss that arises when a person is physically present, but mentally and emotionally absent. Our talk today  aims to provide you with practical strategies to adapt to ambiguous loss and navigate the complex emotions that come with caring for someone living with Dementia. Ambiguous Loss Psychotherapist Pauline Boss coined the term ambiguous loss to describe a loss that occurs without closure or clear understanding. The concept evolved while working primarily with military families, whereby women who were married to spouses were missing in action during wartime. They did not know if their spouse was alive or dead. Am I a widow? Not a widow? How do I live my life in this state of limbo? In the context of Dementia, ambiguous loss occurs because the person with Dementia is physically here, and not really or consistently here psychologically. In some situations, one may not even remember being married or the names of one’s spouse or children. This is a hard truth to accept. Understanding that anatomical and cellular changes in the brain are underlying the lack of recognition and emotional disconnect may offer some comfort. Another learning is that fatigue and anxiety can actually bring about more forgetfulness and confusion. Families may experience their loved one with Dementia clearer, or more normal, in the mornings after a good night's rest. Later in the afternoon, they seemed less engaged and more forgetful. Families may erroneously conclude that the person is just trying to get attention. When comparing visits, families may feel like they are experiencing two different people, or whoever visits in the afternoon may find their loved one less able to focus, perhaps more anxious or irritable, because the person with Dementia looks the same on the outside. The changes in thinking and behavior can understandably lead to feelings of grief, frustration, and confusion for family and friends who visit in the evenings in attempting to make sense of these changes. Ambiguous loss is a normal and valid reaction. We hope that by understanding the nature of ambiguous loss, families can better cope with the arising emotions and find ways to adapt to their new reality. Start by acknowledging your feelings. It's normal to feel a range of emotions when caring for someone with Dementia, including sadness, guilt, exasperation, and anger. Acknowledge these feelings and allow yourself to experience them without judgment. Continue educating yourself about Dementia on an ongoing basis. Understanding the progression and symptoms can help you make more sense of your loved one's behavior and reduce frustration. Educating yourself can also help you set realistic expectations for your loved one's abilities. Focus on the present moment. Instead of dwelling on the past or worrying about the future, focus on the present moment with your loved one. Engage in activities that bring you joy and allow you to connect with your loved one in meaningful ways. Seek support. Caring for someone with dementia can be isolating, so it's important to seek support from others who understand what you're going through. Practice self-care. Caring for someone who lives with Dementia can be physically and emotionally draining. Make time for activities that help you relax and recharge, such as exercise, meditation, or spending time with friends. Set realistic expectations. Recognize that you may need to adjust your expectations for your loved one's behavior and abilities as their Dementia progresses. Focus on what they can still do rather than what they have lost. Maintain a sense of humor. Sometimes, finding humor in difficult situations can help lighten the mood and reduce stress. Look for moments of joy and laughter in your interactions with your loved one. Find meaning and purpose. Despite the challenges of Dementia caregiving, many caregivers find meaning and purpose in their role. Focus on the positive aspects of caregiving, such as the opportunity to show love and compassion in ways you did not know possible to your loved one. Seek professional help. If you are struggling to cope with the challenges of Dementia caregiving, don't hesitate to seek help from a mental health professional. If you are feeling persistent anger, resentment, and irritability, it is wise to connect with a therapist for more intense counseling. Therapy can give you the support and coping strategies to navigate this difficult time. In conclusion, practice gratitude. Cultivating a sense of gratitude for the time you have with your loved one, despite the challenges, can help shift your perspective and foster resilience. Caring for someone with Dementia is a challenging and emotional journey, but it's important to remember that you are not alone. By acknowledging your feelings, seeking support, and practicing self-care, you can adapt to the ambiguous loss that comes with Dementia, caregiving, and find meaning and purpose in your role. Thank you for being with me. Ambiguous loss is challenging by its very nature, and yet you choose to join us today to watch, listen, and learn, so that you can deal meaningfully with the grief and undeniable changes. Those are characteristics of a healthy and curious mind, a mind well prepared to take positive steps forward at the most appropriate pace. Thank you again.

The health benefits that various foods and diets to improve overall health or lower risk for disease is a newsworthy topic. Some articles promote that eating fiber-rich fruits, vegetables, and whole grains helps us to maintain a healthy weight, as well as lowering our risk for colon cancer. Others assert the Mediterranean diet – one which encourages replacing red meat for fish and chicken, saturated fats with olive oil, and refined carbohydrates with whole grains – reduces the risk for heart disease, certain cancers, and diabetes. There are many research studies touting the benefits of red wine on lowering cholesterol blood levels and thereby reducing the risk for heart disease, strokes, cataracts, and colon cancer. Though a controversial area of research, some studies indicate drinking moderate amounts of red wine may slow declines in brain function. With respect to consuming wine and other alcoholic beverages, moderation is the keyword. However, most people are unsure of how much a moderate amount is. According to the Dietary Guidelines for Americans, a low to moderate alcohol consumption is no more than one drink a day for women and older adults, and two for men. One drink is usually 1 1/2 ounces or 15 grams of alcohol, which equals approximately 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof liquor. (See Note 1 below.) These dietary guidelines refer to the amount consumed on any single day and not as an average over several days. In other words: Do not save your daily allocation for a weekend binge. Alcohol-related brain damage, (ARBD) conditions that include Wernicke-Korsakoff Syndrome and alcoholic Dementia, is the result of drinking too much alcohol over the course of several years. Though both types of ARBD exhibit dementia-like symptoms, neither condition is true dementia. The difference between ARBD and Dementia such as Vascular, Lewy body, or Alzheimer’s disease is in the ability to treat or stop the progression of symptoms. Consuming more than the recommended amounts of alcohol does increase the likelihood of developing Alzheimer’s disease and Vascular Dementia later in life. However, researchers have yet to establish the numerical relationship between alcohol consumption and risk for Dementia. The reasons are many and include research entirely dependent on reported observations and evaluating the variables that, in combination with alcohol consumption, affect the long-term risk for Dementia. However, one can state with certainty the more you drink the greater the likelihood of developing dementia later in life. High alcohol consumption also increases the risk for stroke, heart and liver disease, and depression – all of which are well-known dementia risk factors. Note: 1. U.S. Department of Health and Human Services and U.S. Department of Agriculture, 2015. 2020 Dietary Guidelines for Americans. 8th Edition, Washington, DC; 2015, (accessed June 15, 2015). Content Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of " An Unintended Journey: A Caregiver's Guide to Dementia.", available through Amazon. Please visit our Author's page to learn more and find this title. The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts- that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

The concept of keeping a gratitude journal has gained attention as a focal point for brain writings and research. Forbes published an article within recent years that explored the value of keeping a gratitude journal. Something happens neurologically when we reflect on our choices, relationships, and special events in our lives. Actively reflecting starts to hardwire neurological changes in the brain. If you’re constantly focusing on emotions that make you fearful, angry and resentful, they eventually get hardwired into your brain. The opposite outcome holds true for gratitude. Research has found that keeping a gratitude journal can help pull you out of negative patterns and start you on a course that leads to positive thoughts and actions. Gratitude journals have been shown to be even more effective than simply focusing on having positive thoughts in your day. Keeping one has many different benefits: One of the biggest improvements comes with the ability to open up new relationships, or to communicate better in your current relationships. Reflecting and being grateful for the people that help you in life expands your empathy, and empathy is one of the cornerstones of healthy relationships. It also improves physical health. Research, published in 2012 in the Journal of Personality and Individual Differences, found that people stuck in negative emotional patterns feel pain more intensely than people who practice gratitude and positive thinking on a daily basis. Keeping a gratitude journal also helps people manage depression and feelings of aggression. A study published by the Journal of Applied Psychology found that people who wrote in a gratitude journal for 15 minutes at night before going to bed experienced better quality of sleep on a regular basis. It also has a positive impact on self-esteem. Sitting down to reflect on what you’ve accomplished and what you’re grateful for ingrains the value of the experience in your memory. This also helps to reduce social comparisons, because focusing on what you appreciate about yourself impedes the negative impulse to judge others. Gratitude journaling has also been shown to be a therapeutic tool that can help people deal with conditions like PTSD and other stress-related disorders. It costs little more than a cheap composition notebook or simply maintaining a special file on your computer’s hard drive. I think you’ll find if you take the time to reflect on your life and the things you’re grateful for, results will be nothing short of amazing. Contributor: Dr. Michael Trayford is a Board-Certified Chiropractic Neurologist and Founder of APEX Brain Centers in Asheville, NC. The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society of America does not provide medical advice. Please consult your doctor.

Hearing connects us to the world, helping us communicate, work, socialize and be alert to potential danger. Hearing impairment, likely affecting over 30% of seniors, touches all aspects of daily living. It contributes to depression, loneliness, poor job performance, and in the long run, may lead to Dementia. It is thought by some, that untreated hearing loss could be responsible for 9% of Dementia worldwide. The good news is that healthy lifestyle choices that include correction of hearing loss, might possibly delay or prevent one-third of Dementia cases. Here is a guide to understanding hearing loss and what to do about it: What causes hearing loss? Age Genetics (family history) Chronic illness (type-2 diabetes, hypertension, cardiovascular, autoimmune, and infectious diseases) Medication (diuretics, antibiotics, chemotherapy, others) Environment (noise, pollution, industrial chemicals) Head trauma Smoking And more... We can’t change our genetics, but we can take steps to affect the other factors. What are the types of hearing loss? Peripheral hearing loss occurs in the ear, while central loss involves parts of the brain that process auditory signals. Hearing loss is often a mix of both types. How does hearing loss cause Dementia? It increases social isolation, reduces stimulation to the brain, and/or it may arise from the same brain changes that cause dementia. What does testing involve? To be thorough, take three tests: Ear testing: wear headphones while identifying short sounds played at different volumes and pitches. Central auditory processing (CAP) evaluation: checks speech reception and word recognition using the Staggered Spondaic Word Test (SSW) and the Synthetic Sentence Identification with Ipsilateral Competing Message test (SSI-ICM). Cognition: The Montreal Cognitive Assessment (MOCA), available online, for free, in multiple languages and dialects, is one page and takes ten minutes. MOCA detects mild cognitive impairment and early dementia. What treatment is available? Hearing aids make sounds louder and easier to pick up. Middle or inner (cochlear) ear implants boost signals that go to the brain. Treatment slows mental decline and improves cognitive test scores, so sooner is better. What lifestyle strategies support hearing? : Moderate alcohol consumption Bone-strengthening exercise Antioxidant (Mediterranean, DASH) diets Stop smoking Correcting hearing loss improves life enjoyment, daily function, and brain health. Take action today to help counter this modifiable risk factor for Dementia. References: www.ncbi.nlm.nih.gov/pubmed/29964378 www.ncbi.nlm.nih.gov/pubmed/29735277 www.ncbi.nlm.nih.gov/pubmed/29212633 www.thelancet.com/commissions/dementia2017?code=lancet-site www.ncbi.nlm.nih.gov/pubmed/29937713 www.ncbi.nlm.nih.gov/pubmed/30011159 www.ncbi.nlm.nih.gov/pubmed/29430246 www.ncbi.nlm.nih.gov/pubmed/28894825 www.ncbi.nlm.nih.gov/pubmed/27806352 www.ncbi.nlm.nih.gov/pubmed/29937713 Contributing Blogger: Jennie Ann Freiman, MD, author of The SEEDS Plan. The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc . We do not endorse or guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor.

Blood pressure and health is a frequent topic of a casual conversation between friends. However, many people are not aware of the relationship between blood pressure and the risk of having dementia later in life. Blood pressure is a measure of the force blood exerts against the inner walls of the blood vessels and arteries as the heart pumps blood throughout the body. The first or higher number, the systolic pressure, determines the pressure in the arteries when the heart muscle contracts. A higher than normal pressure, one that is greater than 120, causes the heart to work harder and increases the risk for heart attacks, and strokes. The second number, the diastolic pressure, determines the pressure in the arteries when the heart muscle relaxes between heartbeats. A lower than normal blood pressure is having a systolic pressure below 90 or a diastolic lower than 60. Most doctors consider chronically low blood pressure a problem only if it causes noticeable symptoms such as dizziness, fainting, or rapid and shallow breathing. Some causes for too-high or too-low blood pressure are cardiovascular and neurological abnormalities present at birth and the side effects of certain medications. Conditions and behaviors such as blood pressure, chronic kidney disease, heart disease, obesity, smoking, and insufficient exercise are all causes for having high blood pressure. Risk factors associated with having low blood pressure include advanced age, medications such as the alpha-blockers used to treat high blood pressure, as well as having diseases such as diabetes, Parkinson's disease, severe infections, and certain heart conditions. High blood pressure, independent of its cause, increases the risk of having Dementia. However, the good news is there are ways to decrease the risk for Alzheimer's disease and vascular dementia - the two most common types of Dementia. Some of these include reducing stress, eating a heart-healthy diet, getting regular exercise, and stopping smoking. It’s also important to follow your doctor’s instructions and take your blood pressure medication as prescribed. Changing lifelong habits is often easier said than done. It’s difficult to reduce stress and to find the time to exercise when juggling the responsibilities of a tightly scheduled day. When eating out, or socializing with family, friends, and coworkers, it is a challenge to manage large portions and to choose foods that are low in saturated fats, salt and added sugar. Support groups as well as your friends and family can be your best allies in helping you to achieve a healthier lifestyle. However, be sure to tell your friends and family the reason for making these lifestyle changes is to reduce your risk for dementia. Maybe, just maybe, your explanation will be the motivation they need to make similar healthful changes. Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Bodyweight and risk for Dementia are both confusing and complex topics. One can find reports that state obesity increases the risk for dementia as well as ones that indicate the opposite –that being underweight is the risk factor. And to make things even more confusing, there is evidence that indicates being overweight may protect some people from Dementia.* It’s needless to say, these unexpected findings are difficult to explain and generate considerable discussion and controversy both in the media and between researchers. However, what these seemingly conflicting findings show is a risk – the factors that influence the likelihood of having Dementia is difficult to assess. A too high body mass index (BMI), which uses an equation to calculate a numerical rating of your health based on height and weight, is only one of many known risk factors. Therefore the big challenge is how to determine the combined effects of having multiple risk factors, such as diabetes, insufficient exercise, and smoking. Does having additional factors make having dementia three times more likely than being overweight alone? Or perhaps the risks compound and put people at 10 times the risk for Dementia? Is it possible that having a high BMI becomes protective when combined with habits and activities known to reduce risk? As you can see, the number of environmental, behavioral, health-related, and genetic influences is huge and the combinations of risk factors are infinite. Another challenge is separating associative risks from those that cause the outcome. For example, obesity is associated with increased risk for diabetes, but in itself does not cause diabetes. What causes diabetes is the inability of the pancreas to produce sufficient insulin. And, as it turns out, having diabetes is a risk factor associated with having dementia later in life. Therefore, based on what we currently know about BMI and risk for Dementia the best answer is, “it depends.” This means, at this time, the best we can do to reduce risk is to make a lifelong commitment to what current clinical research shows are health-promoting habits. * The Lancet Diabetes and Endocrinology, http://www.thelancet.com/journals/landia/article/PIIS2213-8587(15)00033-9/abstract , Accessed: September 2016. Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon. The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse or guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Traumatic brain injury (TBI) describes situations in which an external force, such as a fall or a blow to blow to the head, causes extreme pain that is often accompanied by a short or a long period of unconsciousness. People who experience multiple traumatic brain injuries are at high risk of developing dementia later in life. (1) However, the critical phrase "increase risk for" means that TBIs do not cause dementia but increase the likelihood of dementia sometime in the future. In a recent and extensive review of the research literature, Sharan Shively, MD, Ph.D., and colleagues report that a history of moderate and severe TBIs increases the risk of having late-life dementia 2 - to - 4 times that of people who have never experienced a traumatic brain injury. (2) To come to this conclusion, Shively and colleagues reference earlier studies that compare the presence or absence of later-in-life dementia in people who suffered concussions of sufficient severity to cause loss of consciousness to individuals who report never having experienced that degree of head trauma. (2) People who experience multiple traumatic brain injuries are at high risk of developing dementia later in life. (1) The syndrome, associated with having multiple traumatic brain injuries, was initially described in 1928. Called dementia pugilistic, or "punch drunk," was first observed in boxers who suffered repeated knock-outs. (3) It took many more years of casual observation before medical researchers linked a history of repeated sports and military-related head injuries to the onset of dementia symptoms later in life. The condition, chronic traumatic encephalopathy (CTE), now receives considerable coverage in the public media. Signs and symptoms of CTE usually begin eight to 10 years after traumatic brain injuries. They include difficulty thinking, impulsive behavior, memory loss, substance abuse, and suicidal thoughts or behavior. (4) Over time, the changes caused by CTE worsen and progress to aggressive behaviors, tremors, and speech and language difficulties. (4) More than one-third of people with CTE eventually show signs of other degenerative brain diseases such as dementia and Parkinson's disease. (3) Undoubtedly, ongoing and future research will improve our understanding of traumatic brain injuries and their relationship to later-in-life dementia. In the meantime, you can reduce the likelihood of receiving a head injury by trip-proofing your home, being observant of hazards such as low tree branches and open kitchen cabinet doors, as well as by wearing a helmet to prevent sports-related injuries. Even if you have experienced multiple head injuries, you may be able to reduce your overall risk of developing dementia by implementing lifestyle changes that include such things as maintaining a healthy weight, eating a heart-healthy diet, as well as participating in an assortment of physical, social, and mental activities. Notes: 1. Alzheimer's: Can a head injury increase my risk? http://bit.ly/3trmpdM. (accessed November 12, 2022) 2. Shively et al., "Dementia Resulting from Traumatic Brain Injury" https://www.researchgate.net/publication/229011632_Dementia_Resulting_From_Traumatic_Brain_Injury_What_Is_the_Pathology (accessed March 22, 2016) 3. What Is Chronic Traumatic Encephalopathy?, http://www.brainline.org/content/2010/12/what-is-chronic-traumatic-encephalopathy.html (accessed April 7, 2016) 4. Chronic Traumatic Encephalopathy, https://www.mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/symptoms-causes/syc-20370921 (accessed April 6, 2016) Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of "An Unintended Journey: A Caregiver's Guide to Dementia." Available through Amazon. The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse or guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

The health benefits that various foods and diets to improve overall health or lower risk for disease is a newsworthy topic. Some reporters state that eating fiber-rich fruits, vegetables, and whole grains helps us to maintain a healthy weight as well as may lower the risk for colon cancer. Others assert the Mediterranean diet, one which encourages replacing red meat for fish and chicken, saturated fats with olive oil, and refined carbohydrates with whole grains, reduces the risk for heart disease, certain cancers, and diabetes. Many research studies are touting the benefits of red wine on lowering cholesterol blood levels and thereby reducing the risk of heart disease, strokes, cataracts, and colon cancer. Though a controversial area of research, some studies indicate drinking moderate amounts of red wine may slow declines in brain function. With respect to consuming wine and other alcoholic beverages - moderation is the keyword. However, most people are unsure of how much is a moderate amount. According to the Dietary Guidelines for Americans, a low to moderate alcohol consumption is no more than one drink a day for women and older adults, and two for men. One drink is usually one 1/2 ounce or 15 grams of alcohol, which equals approximately 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof liquor. (Note 1) These dietary guidelines refer to the amount consumed on any single day and not as an average over several days. In other words - do not save your daily allocation for a weekend binge. Alcohol-related brain damage, (ARBD) conditions that include Wernicke-Korsakoff syndrome (WKS) and alcoholic Dementia are the result of drinking too much alcohol over several years. (Note 2) Though both types of ARBD exhibit Dementia-like symptoms, neither condition is true-Dementia. (Note 2) The difference between ARBD and Dementia such as Alzheimer's disease is in the ability to treat or stop the progression of symptoms. Consuming more than the recommended amounts of alcohol does increase the likelihood of developing Alzheimer's disease and vascular dementia later in life. However, researchers have yet to establish the scientifically measurable relationship between alcohol consumption and risk for Dementia. The reasons are many and include research entirely dependent on reported observations and evaluating the variables that, in combination with alcohol consumption, affect the long-term risk for Dementia. However, one can state with certainty, the more you drink, the greater the likelihood of developing dementia later in life. High alcohol consumption also increases the risk for stroke, heart and liver disease, and depression – all of which are well-known Dementia risk factors. Notes: 1. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition, Washington, DC; 2015, http://health.gov/dietaryguidelines/2015/guidelines/ (accessed June 15, 2015). 2. What is Alcohol-related Brain Damage?, https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=98 (accessed June 16, 2016). Content Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of " An Unintended Journey: A Caregiver's Guide to Dementia.", available through Amazon. Please visit our Author's page to learn more and find this title. The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

“Use it or lose it" is a common expression we hear referring to physical and athletic abilities, maintaining hands-on skills, or the capabilities that come with formal education. Similar to how physical fitness improves health and quality of life, brain fitness as a product of intellectual stimulation may reduce risk or help slow or lessen the impacts of Dementia. Researchers and healthcare professionals use the terms “brain reserve” and “cognitive reserve” to describe the protective factors that brain anatomy and education have on the onset and progression of dementia. Often, researchers and clinicians do not distinguish between the two and use the term cognitive reserve. However, there are subtle differences between the two kinds of reserve. One can think of brain reserve as computer hardware and cognitive reserve as operating software. Brain reserve, rather than reducing the risk for Dementia, is brain resiliency or the ability to maintain adequate function in the face of increasing brain damage. In this case, researchers believe it is inborn brain architecture along with the number of neurons and connections between brain structures that create resiliency. Physical methods such as using microscopes to examine pieces of brain tissue and medical imaging technologies to locate areas of high and low brain activity are the ways researchers assess brain reserve. Cognitive reserve is the effect brain exercise has on making the brain better able to resist the behavioral and intellectual declines Dementia cause. Researchers and clinicians use behavioral assessments to evaluate cognitive resiliency, such as the mini-mental status exam. Brain fitness is one of the best ways to reduce the risk of age-related dementia. And should Dementia enter your life, brain fitness may help to slow or lessen the impacts of the disease. Participating in physical activities such as baseball, flying radio control airplanes, hiking, or dancing requires both coordination and the ability to make split-second decisions. Fortify Your Brain Hands-on learning refers to making something or acquiring a new skill. Whether self-taught or with the assistance of a knowledgeable person learning how to build furniture, watercolor, construct a raised-bed garden, or become proficient at using Photoshop, requires high-level thinking and problem solving, concentration, and creativity. Levels of participation in both physical, hands-on activities and formal education reduce the risk for Dementia and make the brain better able to resist the behavioral and intellectual declines of Dementia. Sadly, the progressive nature of Dementia eventually overwhelms the cognitive reserve that once supported adequate behaviors and abilities. When this happens, there is a rapid decline in cognition as well as in the ability to perform tasks of daily living such as getting dressed without assistance. Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through A mazon . The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org